Exploration of the Trend Analysis of RIF-Resistance Tuberculosis: A Case of Masvingo Province, Zimbabwe

Abstract

Tuberculosis (TB) continues to be a critical global public health challenge, particularly in Masvingo province, Zimbabwe, where healthcare resources are limited. This study primarily focused on the trend analysis of the total number of TB samples, TB samples from HIV-positive individuals, TB-positive cases, and rifampicin-resistant (Rif-resistant) TB cases in Masvingo province, as observed across three distinct periods: the pre-COVID-19 period (2018–2019), the COVID-19 period (2020–2021), and the post-COVID-19 period (2022–2023). The researcher employed a mixed-methods approach, utilizing quantitative data from 10 laboratories in Masvingo Province equipped with GeneXpert machines (diagnostic tools used for diagnosis of TB), along with qualitative information from seven district TB coordinators and one provincial TB coordinator to supplement the results obtained from the quantitative analysis. The quantitative analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 20. A two-sample proportional test was employed to depict the trend analysis and contributing factors for the total number of TB samples, TB samples from HIV-positive individuals, TB-positive cases, and Rif-resistant TB cases. The results indicated that the proportion of TB samples collected during the pre-COVID-19 period (41.0%) was significantly higher than during the pandemic (31.0%), a difference that was statistically significant (p = 0.000 < 0.05). Qualitative analysis revealed that limited healthcare access during the pandemic, due to travel restrictions from government lockdowns, contributed to this decline. Notably, the proportion of TB samples from HIV-positive individuals increased during the COVID-19 period (35.0%) compared to the pre-pandemic period (33.9%), a difference that was statistically significant (p = 0.015 < 0.05). This suggests that the combined vulnerabilities of HIV and COVID-19 led to increased healthcare interactions, supported by qualitative insights indicating that people living with HIV were viewed as high-risk and had more contact with medical practitioners. Temporal variations in TB positivity rates were evident, with a higher proportion of positive cases recorded in the pre-COVID-19 era (39.5%) compared to the pandemic (29.37%), a difference that was statistically significant (p = 0.000 < 0.05). This decline may indicate a recovery of healthcare services or improved patient adherence to treatment due to heightened health awareness during the pandemic. A significant decline in rifampicin-resistant TB (RR-TB) cases was also observed between the COVID-19 period (39.22%) and the post-COVID-19 period (17.65%), a difference that was statistically significant (p = 0.001 < 0.05), suggesting a recovery of healthcare services or improved patient adherence to treatment as a result of increased health awareness during the pandemic. COVID-19 negatively affected the TB continuum of care regressing the gains that had been made towards the END TB Strategy. This is evidenced by the drop in the total number of samples collected due to a reduction in the presumption rate, the pick in TB samples from HIV-positive clients, and a pick in Rif-resistance TB.